Growing Up: Sexually Healthy and Personally Empowered Adolescents PDF

SHAPE 1 GROWING UP  Sexually Healthy and Personally Empowered Adolescents INTRODUCTION Puberty signals the beginning of adolescence. It refers to the physiological or bodily changes that result in development of sexual and reproductive capacity. It is...

SHAPE 1 GROWING UP  Sexually Healthy and Personally Empowered Adolescents INTRODUCTION Puberty signals the beginning of adolescence. It refers to the physiological or bodily changes that result in development of sexual and reproductive capacity. It is a time of rapid physical growth that brings about confusion, insecurities, and even fear among many adolescents. Helping adolescents understand the bodily changes and assuring them that the changes are normal part of becoming an adult is particularly important. It will help adolescents become comfortable with and make decisions about their changing body. This module begins with identification of puberty changes in males and females, emphasizing growth spurt and sexual and reproductive maturation as the most important changes. It continues with a detailed discussion of sexual and reproductive maturation by illustrating how puberty prepares the body for reproduction (male and female fertility) and how pregnancy occurs (fertilization and sexual intercourse). It advances to an examination of the consequences of early and unprotected sexual intercourse, particularly early childbearing and sexually transmitted infections (STIs) including HIV and AIDS, and ends with a discussion of effective ways of preventing them. LEARNING OBJECTIVE1 At the end of this module, participants are able to: Knowledge Attitude Self-Efficacy Describe the physical changes of Show positive attitude Develop a plan or list of adolescence; towards bodily changes commitments that can be of puberty; done to positively Identify sexual and reproductive nurture the changes organs and describe their functions; Show positive attitude happening in their towards their body, bodies; and Describe how puberty prepares the including sexual and body for reproduction; reproductive parts; Share the learning they gained to their fellow Identify fertile and infertile periods of Acknowledge and respect participants. males and females; differences in physical appearance; Describe how and when pregnancy occurs and how it can be prevented; Recognize diversity in the rate of physical Explain the health risks of early development and pregnancy to mother and baby; maturation; GROWING UP 2 SHAPE Knowledge Attitude Self-Efficacy Identify common complications of Recognize sexual pregnancy in adolescent mothers; abstinence and use of contraceptives or family Discuss the different contraceptives planning methods as or family planning methods; effective protection against pregnancy; and Define STIs, including HIV, and how they are and they are not transmitted; Recognize sexual abstinence and correct Discuss ways to prevent transmission and consistent use of of STIs and HIV; and condom as effective protection against STIs Discuss where and how to access local including HIV. STI and HIV testing and treatment services. 3 GROWING UP  Opening & Materials Time Session Title Learning Objectives Key Topics Closing Activity Needed (Minutes) Pretest Describe personal Opinion Poll Attitude about “Agree,” 30 minutes values in relation to bodily changes “Neutral” their changing bodies and “Disagree” Session 1.1 Describe the physical Body Mapping Meaning of Signage, 90 minutes changes of Pass the puberty large sheets Physical adolescence Rhythm Length of puberty of paper Changes Show positive attitude Body changes in marker LEARNING SESSION towards bodily males and females paper changes at puberty; Diversity in coloring Acknowledge and physical materials respect differences in appearance tapes physical appearance; Recognize diversity in appearance, the rate of physical maturation and development. Session 1.2 Identify sexual and Label the Parts Sexual and Diagrams 90 minutes reproductive organs Fill in the reproductive and labels of Female and and describe their blanks and pass parts and female Male functions; the ball functions internal and Fertility Discuss how puberty Female Fertility external prepares the human Male Fertilization reproductive body for reproduction; parts, and Identify fertile and male infertile periods of external GROWING UP males and females; reproductive parts Sexually Healthy and Personally Empowered Adolescents 4 5 Opening & Materials Time Session Title Learning Objectives Key Topics Closing Activity Needed (Minutes) SHAPE Express positive Envelope attitudes towards Scissors their body including Glue sexual and; GROWING UP reproductive parts Describe how and when pregnancy occurs and how it can be prevented; Explain the health risks of early pregnancy to mother and baby; Identify common complications of pregnancy in adolescent mothers; Discuss the different contraceptive or family planning methods; Recognize sexual abstinence and use of contraceptive as means of preventing pregnancy.  Opening & Materials Time Session Title Learning Objectives Key Topics Closing Activity Needed (Minutes) Session 1.3 Describe how and Short Video Conditions for Short video 90 minutes when pregnancy Showing pregnancy on Teen occurs and how it can Small Group Signs of fertilization Pregnancy be prevented; Discussion pregnancy Video player Explain the health Poster Making Health risks of too like laptop risks of early early pregnancy to or computer pregnancy to mother mothers and baby LCD and baby; Social cost of early Projector Identify common pregnancy Large sheets complications of Sexual abstinence of paper or pregnancy in easel sheet adolescent mothers Coloring Discuss the different materials contraceptive or Adhesive family planning tape methods; Markers Recognize abstinence and use of contraceptive family planning methods as effective. GROWING UP Sexually Healthy and Personally Empowered Adolescents 6 7 Opening & Materials Time Session Title Learning Objectives Key Topics Closing Activity Needed (Minutes) SHAPE Session 1.4 Define STIs, including Primetime STIs Copy of facts 90 minutes HIV, and how they are “Wildfire” HIV and AIDS sheets on Sexually and they are not STI and HIV Transmitted transmitted; and AIDS GROWING UP Infections Discuss ways to prevent transmission of STI and HIV; Discuss where and how to access local STI and HIV testing and treatment services; and Recognize sexual abstinence and correct and consistent use of condom as effective protection against STIs including HIV. Post-test Describe personal Opinion Poll Attitude about “Agree,” 30 minutes values in relation to bodily changes “Neutral” their changing bodies. and “Disagree” labels and statements  Sexually Healthy and Personally Empowered Adolescents MODULE OVERVIEW Discuss the following opening messages: 1. You are all adolescents and you are undergoing bodily changes to become adults. Many of you may be feeling confused or afraid of those changes. Some of you may be feeling excited about the thought of becoming adults. In this module, we will talk about your changing body and understand why the different bodily changes are happening. We will also talk about what it means when girls begin to have periods or menstruation, and also what it means when boys begin to have erections and wet dreams. Lastly, we will talk about the consequences of early and unprotected sex. We will talk about all of these in fun, interactive, and respectful ways. Let us not forget our Ground Rules. 2. This module has four sessions: In Session 1.1 (PHYSICAL CHANGES), we will talk about the different bodily changes you are all experiencing as adolescents. We will do this in a creative and fun way. In small groups, you will create a “body map” to indicate which parts of your body have changed or are changing. Then we will discuss what those changes mean. In Session 1.2 (FEMALE AND MALE FERTILITY), we will discuss how puberty prepares the body for reproduction. We will talk about female and male fertility – or how females are able to bear a child and how males are able to father a child. We will start by distinguishing sexual and reproductive parts and functions of the male and female bodies. We will do this by labelling the parts and functions of the female and male reproductive system. Then we will proceed to understanding how young females and males like you become fertile. In Session 1.3 (TEEN PREGNANCY), we will cover a topic that you and all the people around you are so much concerned about – teenage or adolescent pregnancy. How does pregnancy happen? Why is it a problem for adolescents? What are its health risks to adolescent mothers and their baby? What happens to adolescent girls who got pregnant? What happens to the adolescent father? What are the effective ways to prevent early and unplanned pregnancy? These are the questions that we will answer in this session. GROWING UP 8 SHAPE In Session 1.4 (SEXUALLY TRANSMITTED INFECTIONS), we will deal with STIs including HIV and AIDS. STIs are common among sexually active adolescents and youth. This is often not talked about until recently when more and more adolescent boys are diagnosed to be infected with HIV – the virus that causes the deadly AIDS. Roughly one third of the total number of HIV-infected people in the country belongs to your age group and the number is increasing. Why do young people get these infections? What are the ways to avoid getting these infections? We will talk about them in this final session. PRE-TEST OBJECTIVE Participants are able to describe and express their personal values in relation to their changing bodies. Duration: 30 minutes ACTIVITY. Opinion Poll 1. Explain that this is a pretest activity and participants should not worry because they will not be asked to provide facts and figures. Instead, they will be asked to express their current knowledge and attitude on a set of statements by agreeing or disagreeing with them. 2. Designate one side of the room as AGREE area and the other side of the room as DISAGREE area. 3. Let all participants stand at the center of the room. 4. Instruct them to express their agreement or disagreement to each statement that you will read by going to appropriate corner of the room. Those who express neutrality about the statement (i.e. they are not sure if they fully agree or disagree), will stay at the center of the room. 5. Inform that you will not reveal the correct answer at this point. They will find about them as they go through the different sessions. 9 GROWING UP  Sexually Healthy and Personally Empowered Adolescents 6. For each statement, you may request some volunteers to expound on their responses. Just acknowledge and let them share their responses without confirming or commenting on them. 7. Read the following statements: Statements Agree Neutral Disagree a. Puberty is the time when the body physically changes to become adult. It happens to everybody at the same time. b. Males and females who have not grown as tall as their friends and classmates should worry. Something is wrong with them. They should consult a doctor. c. When girls begin to have menstruation or period, it means they have a disease and should see a doctor at once. d. Puberty includes growth spurt and sexual maturation. Males begin to have erections. This is something that adolescents should worry about. e. Since adolescents can already get pregnant or impregnate, they can engage in sexual activities as they want. f. It is okay for adolescent girls to give-in to the request of her boyfriend to have sex in order for her to express her love. g. Adolescent males are not at risk of any health problem if they engage in sex. h. Adolescents engaging in sexual activities for the first time will not result to pregnancy. GROWING UP 10 SHAPE 11 APPRECIATING MY BODY  Sexually Healthy and Personally Empowered Adolescents SESSION OBJECTIVES At the end of the session, participants are able to: 1. Describe the physical changes of adolescence. 2. Show positive attitude towards bodily changes at puberty. 3. Acknowledge and respect differences in physical appearance. 4. Recognize diversity in the rate of physical maturation and development. Time Allotment Materials Needed Methodology 90 minutes large sheets of paper Big group activity and marker discussion coloring materials adhesive tape name tags OPENING ACTIVITY. Body Mapping 1. Introduce the activity: a. After the first year of your life, the next time you will grow rapidly is during puberty. All of a sudden, you have grown taller and bigger. Your family, relatives, and friends might have been telling you that you are now “nagbibinata” (becoming a young man) and “nagdadalaga” (becoming a young woman or lady). b. What does “pagbibinata” and “pagdadalaga” really mean? c. Apart from growing taller and bigger, what other changes in your body are you experiencing? How do you feel about the changes? What are the changes that you like, don’t like, or don’t understand? We will talk about them in this activity. 2. Divide the group by sex (i.e. boys and girls). Allow gay or transgender participants to join the group they can identify with or they can form their own group. APPRECIATING MY BODY 12 SHAPE 3. Ask each group to: a. Draw on a large sheet of paper a female body (for the all-female groups) or a male body (for the all-male groups), or trace the body of a group member by lying down on the paper. b. Discuss bodily changes the group members have begun to experience. Label the different body parts where changes happen (i.e. pubic hair develops, Adam’s apple appears, etc.). c. Present their output (“body map”) in the big group. 4. After all the groups have presented, process the activity by engaging the participants in a discussion through the following questions: a. How did you feel while making your “body map”? Did you enjoy it? Why or why not? Was it easy or hard? Why was it easy or hard? b. What changes are common to males and females? What are your feelings about the changes happening to your body? What are the changes that you like, don’t like, or don’t understand? c. What questions or specific concerns do you have about your changing bodies? [Write answers on the board or on a large sheet of paper. Explain that you will refer to them as you move to the next step.] d. What have you realized from the activity? 5. Link the discussion with the key messages. KEY MESSAGES 1. All the bodily changes you have indicated on your body maps are part of puberty. At puberty, your bodies are changing. Understanding your changing body will help you become comfortable with the changes. 13 APPRECIATING MY BODY  Sexually Healthy and Personally Empowered Adolescents a. What is puberty? The growth of your body from childhood to adulthood is known as puberty. Puberty is the biological changes of adolescence. It is the time in a boy’s and a girl’s life when their body physically changes to become adults. The body grows bigger and taller. Puberty happens to everybody. But it doesn’t happen to everyone at the same time. At puberty, boys and girls experience two most important physical changes. One is “growth spurt” and the other is “sexual maturation.” “Growth spurt” means the body suddenly grows at a rapid rate. Boys and girls increase in height and weight. At puberty, the body achieves “sexual maturation.” This means that boys and girls have become capable of reproduction. It also includes enlargement of primary sex organs. Ito ang panahon ng inyong pagdadalaga at pagbibinata. [Show the following diagram. Indicate the adolescence phase.] Primary School Adolescence (6-9 years old) (10-19 years old) APPRECIATING MY BODY 14 SHAPE Primary School Adolescence (6-9 years old) (10-19 years old) b. How does puberty start? About two years before you noticed the bodily changes, your brain started the work that will eventually change you from children to adolescents. Two parts of the brain – the hypothalamus and the pituitary gland - start making more growth hormones and sex hormones. The pituitary gland is located at the base of our skull at the back of our head. [Help participants find the location of the pituitary gland by asking them to touch the base of their skull at the back of their head.] The hormones act on other parts of the body to make the changes happen. The hormones that tell the body to sexually mature are testosterone, estrogen, and progesterone. Every human has all these three hormones. Generally, females have more estrogen and progesterone while males have more testosterone. But we all have some of each. c. Puberty happens early for some people and later for others. When does puberty start? ○ Girls generally start puberty earlier than boys. Girls “growth spurt” usually starts when they are around ten (10) years old or sometimes, as early as eight (8). ○ For boys, the first manifestation of changes often happen a little later than they do for girls, somewhere between 10 and 12 years. ○ Boys continue to grow three (3) to four (4) years after most girls have finished growing until age twenty (20) or twenty-one (21). 15 APPRECIATING MY BODY  Sexually Healthy and Personally Empowered Adolescents ○ The start of puberty is influenced by genes inherited from biological parents. Genes are like instructions or codes in the body’s cells that define, for example, a person’s eye color, height, skin color, and even the shape of ears. ○ Start of puberty is also influenced by nutrition (type and amount of food intake) and a host of other factors such as physical activities and presence or absence of serious illnesses. ○ Because of genes, people are different from each other and go through puberty at different times and at different rates. Some people seem to go through all the changes easily and others may have a few problems. ○ Each one of us is unique. Let us respect and accept each one’s uniqueness. 2. Some physical changes are specific to boys and girls while others are the same. Other changes are the same for both. Changes in Boys Changes in Girls Changes in Both Gaining extra weight Bodies become curvier and Growing taller Shoulders get wider hip bones widen Changing body shape Muscles start to get bigger Gaining extra weight, Feeling “moody” and stronger particularly on the hips, to Getting hair on the arms Getting an ‘Adam’s apple’ achieve a “womanly” and legs, under the arms (The larynx or voice box shape. [Emphasize: This and in the pubic area gets larger and sticks out does not mean girls start a (which starts out as fine at the front of the throat. diet to lose weight.] hair then gets thicker and This is nothing to worry. Muscles get bigger and darker as one gets older) When the larynx has stronger, but they do not Sweating more finished growing, the voice become as big as the boys’ Getting oilier skin and will sound ‘normal’ again muscles often some pimples and probably a bit deeper Having sexual feelings than before.) Loss of baby fat Penis gets longer and wider Testes (or testicles) get larger APPRECIATING MY BODY 16 SHAPE Changes in Boys Changes in Girls Changes in Both Breasts look like they’re Breasts start to develop growing a little and become fuller (It Hair also grows on the begins with a small face, like a beard swelling under the nipples Getting erections and may and then grows to become have nocturnal emissions full breasts) or “wet dreams” while Menstruation or period sleeping starts 3. One’s body image can affect self-esteem, decision-making, and behavior. You must learn to love and take care of your bodies and should not conform to society’s standards about bodily appearance that can affect your self-esteem. Love yourself! 4. At puberty, sexual and reproductive organs begin to mature. It’s a big deal when your looks change but the biggest change of all during puberty are things you cannot see. These are the things happening inside the body. 5. Most girls start to have menstruation or monthly period. a. Beginning menstruation or “having a period” is one of the most significant events of puberty for young women. Most girls begin menstruation between the ages of nine (9) and sixteen (16). The average age is twelve (12) or thirteen (13). b. It is advisable for girls who have not menstruated by 16 years old to consult with a medical practitioner. c. It is normal for young women to have an irregular pattern of menstrual cycles when they first start having their period. It can take up to two or more years for young women to establish their regular, more predictable cycles. 6. Boys begin to have erections and wet dreams or nocturnal ejaculation. a. Ejaculation is the expulsion of semen through the penis. The sticky liquid is semen, not urine. It contains millions of invisible sperms. Usually, about a teaspoon of semen is released at a time. Sperms are the male reproductive cells. b. The body continuously produces semen. Thus, if a boy does not masturbate or have sexual intercourse, his semen may be ejaculated during sleep. 17 APPRECIATING MY BODY  Sexually Healthy and Personally Empowered Adolescents 7. Physical maturity is different from emotional maturity. While your reproductive system is already able for pregnancy, parenthood is a totally different concern that requires emotional, financial, and social maturity which you do not still have. 8. What can be done to have an enjoyable and healthy puberty? a. Know and be aware of the various changes that are happening in your body. b. Puberty is a time of rapid physical growth, so taking care of the body is especially important. Take care of yourself by eating healthy foods, exercising, and getting plenty of rest so that your body has the energy to cope with all the growing it still has to do. c. Do not compare yourself with others. Each one goes through puberty at his/her own pace. Do not be pressured by societal standards about bodily appearance because you are unique. d. Consult experts when experiencing unusual changes in your body. APPRECIATING MY BODY 18 SHAPE 9. Synthesis of the key messages: a. At puberty, your bodies are changing. Understanding your changing body will help you become comfortable with the changes. b. Adolescents undergo puberty at different paces or speed. You have different body shapes, sizes, and appearances. There is no “perfect” or “normal” body type. c. Because of genes, the kind of food you eat, the kind of physical activities you engage in, and whether or not you have an illness, your body will reach maturity at your own pace. d. Physical maturity is different from emotional maturity. While your bodies may be ready for parenthood, emotionally, you may not be prepared for the responsibilities of parenthood. e. Make puberty an exciting time for all of you. CLOSING ACTIVITY. Pass the Rhythmii 1. Instruct participants to: a. Sit in a circle. b. In one to two minutes, recall the discussion on puberty and think of how they will complete the statement, “Puberty means” Inform that no one is allowed to repeat what others have said about puberty. This means that they should think of several ways to complete the statement. c. Establish a rhythm by tapping the thighs with your two hands twice, then clapping the hands together twice, and then clapping the hands twice as well of the next person on your right. The next person performs the same actions until the action is past on the last person in the circle. 2. Start the rhythm. Pass it on to the person on your right. Once it is moving steadily through the group, speed it up. 19 APPRECIATING MY BODY  Sexually Healthy and Personally Empowered Adolescents 3. When the clap gets back to you, begin completing the statement, “Puberty means __________” The next person you passed the rhythm to completes the statement and passes on the rhythm to the next person who completes the statement. 4. When the rhythm gets back to you again, stop. Ask how everyone feels. 5. As a final message, say: a. Always remember, everyone goes through puberty although not at the same time. It can be scary if you do not understand why all the changes are happening. It can also be exciting and even empowering to know about puberty changes. It keeps your worries away! We will discuss more about puberty changes in the next sessions. 6. Thank everyone for their cooperation and active participation. FURTHER READINGS FOR FACILITATORS  FACT SHEETS on (Page 68-71) APPRECIATING MY BODY 20 Sexually Healthy and Personally Empowered Adolescents UNDERSTANDING MY FERTILITY 22 SHAPE SESSION OBJECTIVES At the end of the session, participants are able to: 1. Identify sexual and reproductive organs and describe their functions. 2. Discuss how puberty prepares the human body for reproduction. 3. Identify fertile and infertile periods of males and females. 4. Show positive attitude towards their body, including sexual and reproductive parts. Time Allotment Materials Needed Methodology 90 minutes  diagrams and labels of internal female  Big group activity and reproductive parts, external female discussion reproductive parts, internal male reproductive parts, and external male reproductive parts (each set slipped inside an envelope)  scissors  glue OPENING ACTIVITY. Label the Parts 1. Introduce the activity: a. When you reach puberty, your body becomes more mature and ready for reproduction. How is this possible? We will find about it in this session. b. Let us begin by familiarizing ourselves with the sexual and reproductive parts of females and males. c. Sexual and reproductive parts are body parts that are personal or private to each one of us. Some of you may be uncomfortable. So let’s not forget about our Ground Rules. d. Let us be respectful to each other when talking about sexual and reproductive parts. 23 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents 2. Form two all-female groups and two all-male groups. To make everyone feel comfortable, put all-female groups and all-male groups in separate corners of the room. 3. Give out to the all-female groups the female sexual and reproductive envelopes and to the all-male groups the male sexual and reproductive envelopes. 4. Instruct groups to: a. Open the envelope and take out the diagram and pieces of paper containing parts and functions. b. On the diagram, label the parts and show functions. Choose from the pieces of paper the appropriate name and function of each numbered part. 5. In presenting group output: a. Have the groups post their diagrams on the wall within their work area and discuss their output among themselves. b. Ask the groups to switch places (the all-female groups moving to the corner of the all-male groups and vice-versa) and examine the diagrams posted on the wall. 6. Gather all the groups and go through the different parts and functions of the male and female sexual and reproductive systems. Discuss the following: a. External parts and functions of female reproductive system (Reference 1 on page 37); b. Internal parts and functions of female reproductive system (Reference 2 on page 38); c. External parts and functions of male reproductive system (Reference 3 on page 39); and d. Internal parts and functions of male reproductive system (Reference 4 on page 40). UNDERSTANDING MY FERTILITY 24 SHAPE 7. Process the activity by engaging the participants in a discussion through the following questions: a. How did you feel while labeling the male and female sexual and reproductive systems? Why did you feel that way? b. Was the activity easy or difficult? Why was it easy or hard? c. What have you realized about male and female bodies? What similarities and differences do they have? d. What concerns do you have about male and female bodies? 8. Synthesize the sharing by emphasizing: The sexual and reproductive parts determine whether a person is male or female. The male is different from a female in external and internal make-up. Getting familiar with the male and female sexual and reproductive systems makes it easier to understand the changes brought about by puberty. KEY MESSAGES 1. At puberty, you become fertile and ready for reproduction. 2. For girls, fertility is the ability to conceive or become pregnant and bear children. 3. Male fertility is the ability of males to provide healthy sperm capable of starting a healthy pregnancy. A male is fertile if he has the ability to provide healthy sperm capable of starting a healthy pregnancy in a female. 4. You need to be aware of your fertility to make you more responsible in expressing your sexuality. Knowing one’s body and fertility empowers the person to make a healthy, informed and responsible decision on his/her family life aspirations. 25 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents 5. A female is fertile only on certain days of each menstrual cycle and these are only the days when she can become pregnant. Unlike the males who are fertile every day throughout their life, females are fertile only on certain days of each menstrual cycle and these are only the days when they can become pregnant. A female’s “fertile days” are those that fall on the few days before and during ovulation. 6. What is Ovulation? a. Girls are born with two ovaries which both contain thousands of eggs. b. When a girl reaches puberty, the hormone estrogen tells an ovary to release one egg every month. Then the two ovaries take turns releasing an egg each month. When an ovary releases an egg, the process is called ovulation. c. Each month, only one ovary releases an egg. On rare occasions, however, both ovaries release an egg in a month. d. Around the time when the ovary is about to release an egg, females get a whitish and sticky liquid from the vagina. If sexual intercourse happens around this time and sperm is ejaculated into the female’s vagina, the sticky liquid helps sperm travel through the cervix and uterus to meet and join the egg in the fallopian tube. UNDERSTANDING MY FERTILITY 26 SHAPE e. A female’s “fertile days” are days she ovulates. Sperm can survive in the fallopian tubes for as long as five (5) days and the egg, if it is not fertilized, survives for as long as 24 hours. It is difficult to predict the fertile days because the period from the beginning of menstruation to ovulation may change. f. Some females learn how to observe the changes in their secretions and body temperature to track their fertile period. This is called the “fertility awareness” technique. g. If the egg is not fertilized, it leaves the body together with some tissues and blood from the uterus through the vagina. This signals the start of menstruation or beginning of the next menstrual cycle. 7. What is Menstruation? a. Menstruation comes from the Latin word mensis, which means “month.” Most females have a period each month. This is why menstruation is also called “monthly period.” b. Menstruation is when females release fluid, including blood, through their vagina. It happens because the lining of uterus (called endometrium) sheds and leaves the uterus passing through the vagina. c. The first time menstruation happens is called “menarche.” d. Menstruation is part of the female reproductive process just as sperm production is part of the male reproductive process. Only females have menstruation. e. The beginning of menstruation is a natural and very important moment in every girl’s life. It marks the beginning of her transition from being a “girl” to becoming a “woman.” It also signals that her body has become capable of getting pregnant or having a baby. f. There is no “right” or “exact” time for menstruation to begin. Periods will start when the body is ready. Most females, however, start to have menstruation between the ages of 10 and 16. There are those who start to have it earlier or later. 27 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents g. The Menstrual Cycle  A female’s menstrual cycle starts from the first day of one period and lasts until the beginning of the next period. Then the cycle starts again.  A period lasts for a few days (three to seven days). This is the time when the body sheds the ruptured uterus lining. When the period stops, one of the ovaries gets ready to release another egg and the uterus starts to build a thick lining again.  The egg is then released and travels through the fallopian tube.  For a 28-day cycle and 5–day menstrual flow, the following describes what happens inside a female’s reproductive system:  Menstrual Phase (Menstruation or period) o The first day of the cycle is the first day of menstruation. A woman experiences bleeding from her vagina during menstruation which normally lasts from three to five days. o The menstrual phase includes all days of menstrual bleeding. o The bleeding experienced by the woman is actually the shedding of the thickened uterine lining which is prepared in case there is a pregnancy. o During menstruation, the ovaries are resting, the cervix is open allowing the uterine lining to flow to the vagina. o There is no cervical mucus present. UNDERSTANDING MY FERTILITY 28 SHAPE o The basal body temperature is low, around 360 C to 35.50C when a drop in estrogen and progesterone occurs. The period where estrogen and progesterone levels are its lowest-- shedding of endometrial lining took place.  Pre-Ovulatory Phase (preparation of the egg) o The pre-ovulatory phase includes all dry days after the menstrual bleeding stops. The length of the pre-ovulatory phase varies. Some women may not be able to observe dry days after menstruation, especially women with short cycles. o During this phase, the following changes are happening inside a woman’s body: bleeding has stop; egg cells begin to develop and mature; lining of the uterus starts to thicken; mucus forms a plug - this mucus prevents entry of sperms; the cervix is firm and closed (A woman experiences dry feeling and no mucus); and the pre-ovulatory phase is the relatively infertile phase which includes all dry days after the menstrual bleeding stops.  Ovulatory Phase o This is the highlight of a woman’s fertility. It Occurs 12-14 days before the onset of the next menses. o One mature egg is released and stays in the fallopian tube. It can be fertilized by the male sperm for only up to one day or 24 hours. o The uterine lining continues to thicken, ready to receive the fertilized egg. o The cervical mucus is wet, slippery, stretchy, and clear. This mucus helps sperm live and swim to reach the egg. It nourishes the sperms. o The vaginal sensation is wet. o There is a slight dip in the basal body temperature, about 0.50 Celcius. o The cervix is soft and open. o The estrogen drops a bit, but remains high. o Progesterone begins to rise.  Post-Ovulatory Phase o No egg is present. If there is no meeting of egg and sperm, the cell deteriorates and is absorbed. Lining of the uterus has thickened. o The mucus forms a plug again to prevent entry of sperms. 29 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents o Women experience dry feeling with no mucus at all. If mucus is present, it is sticky, cloudy, crumbly, or pasty. o Because there is no pregnancy, the woman will experience menstruation and another cycle begins o The post-ovulatory phase is absolutely infertile phase which covers about 14-16 days. o It has a constant length which is approximately 14-16 days. After ovulation, the follicle is transformed into the corpus luteum, which produces an increasing amount of the hormone called progesterone. h. Tracking your Menstrual Cycle  To keep track of menstrual cycle, when they begin and end – it is helpful to keep a personal calendar. Each month, circle or shade the days when you are having your menstruation. If you do this for a year or two, you will see a regular pattern of your menstruation. This will enable you to easily predict your next period.  Keeping a calendar will also help you to know if your period is late or early. It will inform you whether you have to consult a doctor.  A sample menstrual calendar is shown below.  Using X’s, mark the days when you have your period each month. Use X (light), XX (medium) or XXX (heavy) to show the level of flow for each day. Count the days from the fist X of one period to the fist X of the next. This is the length of your menstrual cycle. Try to work out when your next period will start. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec UNDERSTANDING MY FERTILITY 30 SHAPE 8. A male is considered fertile if he has the ability to provide healthy sperm capable of starting a healthy pregnancy in female. a. Beginning at puberty and for the rest of their life, males are fertile every day for as long as they are healthy although fertility declines with age. b. The main purpose of the male reproductive system is to produce the sperm that is needed to fertilize a female’s egg. Sperm are the male reproductive cells whereas the ova or eggs are the female’s reproductive cells. These two cells are necessary to reproduce or to create a new life or to make a baby. c. How are sperms produced?  Sperm is the male sex cell. Under a very powerful lens or a high magnification, they look like tadpoles. They appear to have a head and a long tail.  To produce healthy sperm, the testicles have to be slightly cooler than normal body temperature – two to three degrees lower. This is why the penis and scrotum hang outside the body. Notice that when it is cold, the penis and scrotum shrink. They draw themselves closer to the body to keep warm. When it is hot, they will hang loose away from the body.  The testicles begin to produce sperm only during puberty. During puberty, the level of the hormone testosterone in the male body begins to rise and this causes the penis and testicles to get bigger, and the testicles to begin producing sperm. 31 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents  During sexual excitement, the testicles and epididymis release sperm that move through the sperm ducts towards the penis. Along the way, they mix with a fluid so they can move more easily. The sperm and this fluid are now called semen. It is whitish and quite sticky. The sperm are too tiny to see – a drop of semen that is the size of the period at the end of this sentence would contain roughly a million sperm. Semen leaves the penis through the urethra. This is a tube that goes through the middle of the penis. (Urine also leaves the body through the urethra, but never at the same time as semen).  From the time boys had their first release of semen, called ejaculation, they have become fertile and able to father a child for the rest of their life. d. What are erections? Erections can occur for any number of reasons, but are usually triggered by sexually arousing thoughts or stimulation. During arousal, hormones, muscles, nerves, and blood vessels all work with one another to create an erection. Nerve signals, sent from the brain to the penis, stimulate muscles to relax. This, in turn, allows blood to flow to the tissue in the penis.  Boys may also experience erections during their sleep, which can sometimes result in a “wet dream,” which occurs if one ejaculates while sleeping. e. When semen spurts out of the penis, it is called ejaculation. It happens when muscles at the base of the penis start to expand and contract (tighten). This pushes the semen through the urethra and out through the tip of the penis. But this will not happen every time you have an erection. It will usually happen if you are very sexually excited.  For every ejaculation, a male releases millions of sperm.  Before the ejaculation, the Cowper’s glands release a drop or two of fluid through the tip of the penis. This is called pre-ejaculate, and it cleans the urethra. The pre-ejaculate alone does not contain a sufficient number of sperms that are strong enough to cause pregnancy (unless sperm from a recent ejaculation are still present).  Once a male ejaculates (inside a female’s vagina), he can cause a pregnancy. 9. FERTILIZATION AND PREGNANCY. When a male’s sperm unites with a female’s egg or ovum, fertilization takes place and pregnancy may happen. a. When a sperm joins with an egg (fertilization), an embryo may be formed. The sex of the embryo is determined by the male’s sperm, not by the female’s egg. UNDERSTANDING MY FERTILITY 32 SHAPE b. A pregnancy results if the embryo attaches to (is implanted in) the lining of the uterus. It is this embryo that will develop into a fetus if the pregnancy continues. 10. Most commonly, pregnancy occurs through vaginal intercourse between a male and a female. a. When the male ejaculates, the semen (containing the sperm) inside the male reproductive organs is released into the female’s vagina. An ejaculation contains at least four million sperm. b. The sperm swims up the vagina, then to the uterus, and move towards the fallopian tubes. c. Hundreds of sperm surround the egg, but only one sperm will be successful to fertilize the egg. d. The egg and sperm join together to form one new cell. Few hours later, this new cell splits to create two cells. These cells continue to split until a ball of cell is formed. This ball of cell is called a “blastocyst.” The blastocyst continues to form more cells as it moves down the fallopian tube. It takes about seven days for the blastocyst to reach the uterus. When in the uterus, the blastocyst attaches itself to the soft lining. 33 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents e. The cells inside the blastocyst will grow into a baby. The cells on the outside join the wall of the uterus and form a protective organ called the “placenta.” The placenta provides the baby with food and oxygen from the mother. 11. Being aware of your own fertility process helps you to take care and protect yourselves from unintended pregnancies. a. While pregnancy can happen due to sexual maturation of adolescents, it is a choice that needs to be made responsibly based on one’s psychological, physical, emotional and financial preparedness. 12. Synthesis of the Key Messages: a. At puberty, boys and girls become fertile. A female is fertile if she has the ability to become pregnant and carry a healthy pregnancy to birth. This means that her ovaries are able to release an egg each month, which when fertilized by sperm, will develop into a baby and delivered after nine months. UNDERSTANDING MY FERTILITY 34 SHAPE b. Females have “fertile days” or certain days in their menstrual cycle when they can become pregnant. These days fall on the day of ovulation – when an ovary releases an egg to the fallopian tube – and five days before ovulation. This period is difficult to predict. It may vary for certain women and on certain menstrual cycle. What is fixed is that 14 days after ovulation, menstruation begins and a new menstrual cycle takes place. c. A male is fertile if he has the ability to provide healthy sperm capable of starting pregnancy in a female. This means that his testicles or testes are able to produce healthy sperm – enough in number and able to swim up to the fallopian tubes – that can fertilize the female’s egg. d. Unlike females, males are fertile from the time of his first ejaculation and through the rest of his life for as long as he is healthy. e. Fertility declines naturally with age for both males and females, although this decline takes place earlier in females. f. When a male’s sperm unites with a female’s egg or ovum, fertilization takes place and pregnancy may happen. g. Most commonly, pregnancy occurs through sexual intercourse between a male and a female – during which the male’s penis enters the female’s vagina and the male ejaculates, releasing sperm. h. While pregnancy can happen due to sexual maturation of adolescents, it is a choice that needs to be made responsibly based on one’s psychological, physical, emotional and financial preparedness. CLOSING ACTIVITY. Fill in the Blanks and Pass the Ball 1. Write each of the following statements on a small piece of paper. Take one of the papers and form a small ball out of it. Place another paper around the small ball. Do the same for the other papers until you are able to form a cabbage-looking ball. a. Every female is born with thousands of eggs in her _______________. [ANSWER: ovaries] 35 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents b. The eggs are so __________ that they cannot be seen by the naked eye. [ANSWER: small] c. Once a girl has reached puberty, a tiny egg matures in one of her ovaries and then travels down through the _________ on its way to the __________. [ANSWERS: fallopian tube; uterus] d. The release of egg from the ovary is called _________. [ANSWER: ovulation] e. If a girl egg cell unites with the sperm, ______takes place. [ANSWER: fertilization] f. The fertilized egg travels to the _______ and attaches to the lining of the uterus and remains there for the next nine months growing into a _______. [ANSWER: uterus; baby] g. If the egg is not fertilized, the uterus sheds away the thick lining it has made to protect a fertilized egg along with some blood, body fluids, and the unfertilized egg. All of them flow through the cervix and then out of the vagina. This blood flow is called _______. [ANSWER: menstruation or period] h. From puberty onwards, males continue to produce ______ in their testicles or testes. [ANSWER: sperm] i. The testes are found inside the ________. [ANSWER: scrotum] j. As the sperm matures, they move from the testicles to the _______ where they will remain to mature for about two weeks. [ANSWER: epididymis] k. From the epididymis, the sperm enters the __________. [ANSWER: vas deferens] UNDERSTANDING MY FERTILITY 36 SHAPE l. From the vas deferens, the sperm passes through the seminal vesicles and the ______, which releases fluids that mix with the sperm to make _______. [ANSWER: prostate gland; semen] m. During ________, the semen travels through the penis and out of the body by way of the urethra, the same tube that carries urine. [ANSWER: ejaculation] n. The _________ is the passageway through from which a man urinates or ejaculates. [ANSWER: urethra] 2. Ask all participants to stand in a circle and give the following mechanics: a. Music will be played and the “cabbage ball” will be passed around the participants. b. When music stops, the “cabbage ball” stays with the person who last touched it. c. The person who holds the “cabbage ball” removes the first layer of paper, reads the statement written on it, and fills in the blank(s) with correct answer(s). d. Repeat the process until the last paper of the “cabbage ball” is opened. 3. As final message, say: a. At puberty, menstruation among females and erections among males are perfectly normal. It means the hormones in their body are working well. How girls handle menstruation and how boys handle erections are our primary concerns. We will talk about them in another session. 4. Thank everyone for their enthusiasm and active participation. FURTHER READINGS FOR FACILITATORS  FACT SHEETS on (Page 72-79) 37 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents Reference Materials for Opening Activity of Session 1.2. Reference 1 External Parts and Functions of Female Reproductive System Part Description Function 1. CLITORIS The clitoris is a small organ, shaped like a Touch stimulation of the nerve endings in flower bud with a bit of tissue forming a the clitoris produces sensations of sexual small “hood.” It contains thousands of pleasure. nerve endings that make it an extremely sensitive organ 2. LABIA MINORA Pair of thin cutaneous folds that form part They function as protective structures that of the vulva, or external female genitalia. surround the clitoris, urinary orifice, and vaginal orifice. 3. LABIA MAJORA The labia majora or outer lips cover are a Their function is to cover and protect the pair of rounded folds of skin and adipose inner, more delicate and sensitive that are part of the external female structures of the vulva, such as the labia genitalia minora, clitoris, urinary orifice, and vaginal orifice. 4. VAGINA The vagina is an elastic canal, leading from During sexual intercourse, the vagina the vulva to the cervix and uterus. functions as the receptacle for the penis and carries sperm to the uterus and fallopian tubes. During childbirth, the vagina acts as the birth canal to conduct the fetus from the uterus and out of the mother’s body. It also provides a passageway for menstrual flow from the uterus and for urine from the bladder to exit outside the body. UNDERSTANDING MY FERTILITY 38 SHAPE Reference 2 Internal Parts and Functions of Female Reproductive System Part Description Function 4. VAGINA Refer to Reference 1 above Refer to Reference 1 above 5. CERVIX The cervix is the lower part of the uterus The function of the cervix is to allow flow of that extends to the top of vagina. menstrual blood from the uterus into the vagina and direct the sperms into the uterus during intercourse. 6. UTERUS The uterus is a hollow, muscular organ The fertilized ovum gets implanted into the that rests above the bladder. It is shaped endometrium and derives nourishment like an upside-down pear that rests above from blood vessels which develop the bladder. exclusively for this purpose. The uterus nurtures the fertilized ovum that develops into the fetus. 7. FALLOPIAN The fallopian tubes are two narrow, four The tubes transport the ova from TUBES to five inches long tubes connecting the the ovary to the uterus each month. In the ovaries to the uterus. presence of sperm and fertilization, the uterine tubes transport the fertilized egg to the uterus for implantation. 8. OVARIES The ovaries are two organs, each having They produce oocytes (eggs) for the size of an almond or a grape. fertilization and they produce the reproductive hormones, oestrogen and progesterone. 39 UNDERSTANDING MY FERTILITY  Sexually Healthy and Personally Empowered Adolescents Reference 3 External Parts and Functions of Male Reproductive System Part Description Function 1. PENIS The penis corresponds to the clitoris in Its reproductive function is to deliver semen the female. It may be filled with blood and into the vagina. It also functions to excrete become hard, and erect in response to urine. sexual urge. 2. TESTICLES The testicles or testes are two ball-shaped Produces sperm and the male hormone (TESTES) glands inside the scrotum. testosterone. 3. SCROTUM The scrotum is a loose bag of skin that The scrotum has a protective function and holds and protects the testicles. acts as a climate control system for the testes. 4. URETHRA The urethra is a tube that runs from the It is the passageway through which semen bladder through the penis. travels out of the body during ejaculation. It is also the passageway of urine out of the body. UNDERSTANDING MY FERTILITY 40 SHAPE Reference 4 Internal Parts and Functions of Male Reproductive System Part Description Function 5. EPIDIDYMIS The epididymis is a long, coiled tube that It transports and stores sperm cells that are rests on the backside of each testicle. produced in the testes. A valve at the bottom of the bladder closes when the penis is erect to prevent urination during ejaculation. 6. VAS DEFERENS These are thick-walled convoluted tubes These tube transports mature sperm to the that are continuous with the cauda urethra, the tube that carries urine or sperm epididymis and connects it to the prostatic to outside of the body, in preparation for urethra. ejaculation. 7. PROSTATE The prostate is a walnut-sized The urethra runs through the center of GLANDS gland located between the bladder and the the prostate, from the bladder to the penis, penis. The prostate is just in front of the letting urine flow out of the body. rectum. The prostate secretes fluid that nourishes and protects sperm. 8. SEMINAL The seminal vesicles are a pair of glands The seminal vesicles produce and store VESICLES that are positioned below the urinary fluid that will eventually become semen. bladder and lateral to the vas deferens. Each vesicle consists of a single tube folded and coiled on itself, with occasional diverticula in its wall. 41 UNDERSTANDING MY FERTILITY Sexually Healthy and Personally Empowered Adolescents PREVENTING TEEN PREGNANCY 42 SHAPE SESSION OBJECTIVES At the end of the session, participants are able to: 1. Explain the health and social risks of early pregnancy to mother and baby. 2. Identify common complications of pregnancy in adolescent mothers. 3. Describe how pregnancy can be prevented. 4. Recognize sexual abstinence and use of contraceptive or family planning as effective protection against pregnancy. Time Allotment Materials Needed Methodology 90 minutes For Option 1  Game/competition  Cardboard for the word (in capital letters): TEEN PREGNANCY  Metacards  Markers  Adhesive tape For Option 2  Metacards  Markers  Adhesive tape  Easel sheet with a drawing of a large fish bone OPENING ACTIVITY (Option 1). Wordscapes 1. Introduce the activity: a. As we have learned from the previous session, our sexual maturation during puberty enables girls to get pregnant and boys to impregnate. But, pregnancy is something that needs full responsibilities that adolescents may not be ready for – physically, emotionally, and financially. 43 PREVENTING TEEN PREGNANCY  Sexually Healthy and Personally Empowered Adolescents b. In this session, let us further understand the implications of teen pregnancy in your growth and development. 2. Post the cardboard with the word: TEEN PREGNANCY. 3. Divide the group into males and females groups. 4. Give the following instructions: a. Just like the android game “Wordscapes,” each group shall form words out of the words TEEN PREGNANCY. For example: PEN. b. Each group shall endeavor to form as many words they can form from the given words. The group that has the highest number of words shall win. 5. After three minutes, stop the group from their work and count the words identified by each group. Reward the winning group. 6. Process the activity by asking: a. What did you feel about the activity? b. What did you learn while doing the activity? 7. Synthesize the activity: a. TEEN PREGNANCY is such a complicated word. More than words, it denotes a critical issue that adolescents are facing nowadays. More and more adolescents get pregnant unintendedly and suffer its life-long consequences. b. In this session, let us further discuss teen pregnancy – what are its implications to your life as adolescents and how to prevent it so that it does not become a barrier to your way of achieving your aspirations. PREVENTING TEEN PREGNANCY 44 SHAPE OPENING ACTIVITY (Option 2). The Fish Bone 1. Introduce the activity with the introductory statements in Option 2. 2. Divide the group into two (e.g. one group for males and the other for females). 3. Give each group a drawing of the fish bone then instruct them with the following: a. Label the head of the fish with the word TEEN PREGNANCY. b. Think of the direct causes of teen pregnancy (e.g. unprotected sex) and post them in the back bone of the fish. c. For each of direct cause, identify underlying causes (e.g. peer pressure). Post the underlying causes on the bones attached to the backbone of the fish. 6. Let each group post their outputs in a designated place. 7. Give each group time to view the outputs of the other group for five minutes. 8. Process the activity by asking: a. What did you feel about the activity? b. What did you learn while doing the activity? 9. Synthesize the activity: a. TEEN PREGNANCY is such a complex reality. It is a result of several factors that should be known and understood by adolescents so they can prevent them from happening. b. In this session, let us discuss further the implications of teenage pregnancy to your life as adolescents particularly in relation to your dreams in life. 45 PREVENTING TEEN PREGNANCY  Sexually Healthy and Personally Empowered Adolescents KEY MESSAGES 1. Early pregnancy among adolescents is caused by complex and interrelated factors. Some of the factors identified by literature include the following [discuss these factors to the outputs of the groups in Opening Activity Option 2]: Individual Efforts Household Efforts Institutional Efforts Demographic Factors Demographic Factors Demographic Factors Age & Sex Family size Population size Birth order Civil status Population Marital status Pyscho-social factors composition Location Parental guidance Population Pyscho-social factors KAP on sexuality and distribution Gender-identity ARH Peers and social circle Self-esteem/self- Parental Peer influence Teenage acceptance values/principles Normative group Social competence Access to media behaviors Pregnancy Access and exposure Socio-economic Local governance to media/Information factors policy and program Communication environment Income Technology (ICT) (availability of Educational status Socio-economic services) Health and nutrition factors School, church, and Employment Income other organizations Educational status and institutions Health and nutrition Local governance Employment Media Socio-economic factors 2. Social norms and peer pressure influence sexual behaviors among adolescents. However, negative peer pressure including engaging in sexual activities should be challenged through critical thinking and assertiveness. a. It is not because “everybody is doing it” that one should be pressured to do the same. Critical thinking and assertiveness are needed to prevent consequences of negative pressures from peers, media, or the society as a whole. b. It is always okay to be different! 3. Too early pregnancy puts the young mother and her baby at risk of health complications and even death. PREVENTING TEEN PREGNANCY 46 SHAPE a. Motherhood at a very young age entails a risk of maternal death that is much greater than average, and the children of young mothers have higher levels of morbidity and mortality. b. Pregnant adolescents are exposed to the following health risks especially when they fail to access timely and appropriate maternal health care:  Obstructed labor or difficult delivery. Adolescent girls are still growing and their pelvis has not yet reached its full size. Pregnancy increases the body’s nutritional needs and can slow down growth size. If an adolescent girl gives birth and her pelvis is not yet at its full, she may suffer from what is called “obstructed labor” delivery or difficult delivery.  Obstetric fistula. A damaging complication of obstructed labor is obstetric fistula. In this case, there is a hole between the vagina and the bladder or rectum. A female afflicted with this condition constantly leaks urine or feces and smells bad.  Unsafe abortion. Overall, complications from unsafe abortion is one of the main causes of maternal deaths. Since most of teenage pregnancies are unintended or unplanned, and because of the shame, social stigma, and unpreparedness of the young mother and father to bear the child, many pregnant girls resort to unsafe abortion. Unsafe abortion can also result in lasting and devastating consequences including, sepsis, perforation of the uterus or intestines, hemorrhage, chronic pelvic infection, and infertility.  Pressure to mental health. Carrying a baby and becoming a mom not only creates physical changes. Women also go through mental changes. Young moms face added stress from sleepless nights, arranging child care, social stigma, and attempting to finish schooling. c. The baby of adolescent mothers or teen moms are also exposed to medical complications. Studies have shown that children among mothers have higher levels of mortality and morbidity (diseases). Some of the health risks among babies born from young mothers include:  Babies of adolescent mothers are likely to have low birth weight;  They may also run a higher risk of being premature; and  Have a higher risk of dying before delivery. 47 PREVENTING TEEN PREGNANCY  Sexually Healthy and Personally Empowered Adolescents 4. Too early pregnancy puts you at risk of having DISRUPTED dreams and aspirations (i.e. social cost of teenage pregnancy): a. D – Dropping-out of school due to difficulty of balancing the physical stress of carrying a child and completing studies; b. I – Incapacity to assume parental and familial responsibilities further resulting to incapacity of young couples to raise their child and family responsibly; c. S – Social stigma and discrimination attached to negative and prevailing assumption of social promiscuity among pregnant adolescents; d. R – Repeat pregnancy especially resulting from continued exposure to sexual activities with the mother’s partner; e. U – Unemployment or underemployment – primarily due to lack of education or training required for available or higher paying jobs; f. P – Poverty – Without education and employment, young parents have high vulnerability to poverty; g. T – Taking illegal drugs or substance abuse – as a means to “escape” from or deal with the difficulties of being a young mother or father; h. E – Emotional instability or crisis due to the pressure and tension from taking care of the pregnancy, social stigma, and lack of family support, among others; and i. D – Dependence to family and government on basic needs – as young couples are unable to provide for their needs, they will be highly reliant to their families and to the government. 5. Too early pregnancy also affects the adolescent father: a. Inability to cope with the demands of fatherhood; b. Isolation from friends; c. Inability to relate with equally young and inexperienced wife; and PREVENTING TEEN PREGNANCY 48 SHAPE d. Opposition or inadequate support from their family. 6. To prevent early and unwanted pregnancy, you should abstain from or delay the debut of your sexual relations. a. Not engaging in sex or abstinence is the safest and most effective way to prevent pregnancy. Adolescents need the capacity to refuse, abstain, or at least delay engagement in sexual intercourse. For this, adolescents need proper information about their sexuality so they can be effectively guided in making responsible decisions. b. For sexually active adolescents, correct and consistent use of contraception (or family planning method) can prevent pregnancy. All adolescents regardless of age and sex are allowed by law to seek reproductive health or family planning information from any health facility or services provider. However, the Responsible Parenthood and Reproductive Health law requires parental consent from adolescents below 18 years old for accessing modern methods of contraception. 7. Mutual consent is a requirement before any sexual activity with a partner. Any unwanted sexual activity that happens when one partner is pressured, tricked, threatened, or forced in a nonphysical way by the other partner is sexual coercion. a. Coercion can also make one think she/he owes sex to someone such as her boyfriend (i.e. for fear of being abandoned). b. Sexual coercion and harassment are violations of human rights that need to be reported to authorities. 8. There are medically and legally safe and acceptable methods of contraception or family planning (FP) that can prevent adolescents from getting pregnant and STIs. Access of minors (below 18 years old) to modern methods of family planning requires parental consent. a. Different methods of contraception have different mechanism of action, effectiveness rate, benefit or advantages, and side-effects. It is important for any user to receive full information about these methods so they can decide based on informed choice and voluntarism. 49 PREVENTING TEEN PREGNANCY  Sexually Healthy and Personally Empowered Adolescents b. The various family planning or contraceptive methods available and certified as non-abortifacient in the country are as follows: FP Methods Description Barrier methods  This contraceptive method offer the greatest protection against infection. They are inserted or put on each time the partners have sex. These are called “barrier methods” because they create a barrier between the egg and the sperm, making fertilization impossible.  Condoms are the only contraceptive method that protects Condom partners from sexually transmitted infections including HIV. Hormonal methods  These methods regulate or stop ovulation and prevent pregnancy. Hormones can be introduced into the body through Pills various methods including pills, injections, and subdermal implants. These methods prevent ovulation and thicken cervical mucus, which helps block the sperm from reaching the egg. Injectables  These methods do not protect against STIs. Combining the use of one of these methods with a male or female condom can offer greater protection against both pregnancy and STIs including HIV. Subdermal Implants PREVENTING TEEN PREGNANCY 50 SHAPE FP Methods Description Long acting and  The “long acting and permanent methods” offer longer or permanent methods permanent protection against pregnancy. These methods offer no protection against STIs including HIV.  They include insertion of an Intrauterine Device (IUD), Bilateral Tubal Ligation (BTL), and No-Scalpel Vasectomy (NSV). ○ The IUD prevents sperm from meeting the egg by causing a chemical change that damages sperm and cell before they Bilateral Tubal Ligation can meet. The IUD has long lasting effectiveness (12 years). Insertion and removal of the device is done by a trained service provider. ○ BTL is a safe and simple surgical procedure that provides permanent contraception to women who do not want more children. The procedure involves cutting or blocking the two Vasectomy fallopian tubes so that eggs released from the ovaries cannot move down the tubes, and so they do not meet with the sperm. o NSV is a permanent method of contraception for men that involves tying or cutting of the vas deferens (the tube that serves as passageway of sperm) through a small opening on Intrauterine Device the scrotal sac.   Users of these methods need to undergo comprehensive counseling from trained service providers. 51 PREVENTING TEEN PREGNANCY  Sexually Healthy and Personally Empowered Adolescents FP Methods Description Fertility Awareness-  The “fertility awareness-based methods” or “modern natural Based Methods family planning methods” involve determining the fertile and infertile periods of females within the menstrual cycle and observing the signs and symptoms of fertile and infertile periods. These methods include daily observation of cervical secretions, changes in the basal body temperature, or both changes. o These methods entail learning about the menstrual cycle and to practice observing and recording cyclical changes in her own body. o During the fertile days of the menstrual cycle, partners may use a contraceptive method such as the condom, or they may avoid having vaginal intercourse. o Younger adolescent girls often have irregular cycles, which makes it difficult for them to use these methods effectively. o These methods do not protect against STIs including HIV. 9. Preventing teenage pregnancy requires the participation of both male and female adolescents. Boys can prevent teenage pregnancy by: a. abstaining from sex; b. communicating with his female partner and respecting his partner’s decision not to have sex; c. educating himself about the different contraceptive or family planning methods; d. using condoms correctly and consistently for sexually active adolescents; e. avoiding risky behaviors such as smoking, drinking, and taking illegal drugs; and f. supporting his partner to finish her education towards the achievement of their aspirations or dreams. PREVENTING TEEN PREGNANCY 52 SHAPE 10. Synthesize the discussion with the following: a. Engaging in unsafe sexual intercourse may lead to pregnancy. Too early adolescent or teen pregnancy puts mother and baby at risk of health complications. In addition, it causes adolescent mothers, and also adolescent fathers, to stop schooling, and bear its social cost. b. The surest way to prevent pregnancy is NOT to have sexual intercourse. Everyone has the right to refuse sex. Everyone should respect that right. c. People who have become sexually active but do not want a pregnancy can choose to use contraception. d. Contraception or family planning is any method used to prevent pregnancy. Different methods are used in different ways and at different times. e. Consulting a health care provider can help in choosing a suitable contraceptive or family planning method. Those below 18 years old, however, need parental consent to access contraceptive or family planning services. OPENING ACTIVITY (Option 1). Role Playing 1. Explain: a. Adolescents who are not here with us must also know about the consequences of early, unintended pregnancy. b. To share the information to them, you will go back to your small group. c. In your group, create a short skit where you will use your poster to inform adolescents in your school about the health risks and social cost of early and unwanted pregnancy. You have 10 minutes to plan for your skit. Make sure that each group member has a role to play. 2. Ask each group to present its short skit. 53 PREVENTING TEEN PREGNANCY  Sexually Healthy and Personally Empowered Adolescents 3. As a final message, say: a. The surest way to prevent a pregnancy is not to engage in sex. Everyone has the right to refuse sex. Everyone should respect that right. b. If you have become sexually active and you do not want a pregnancy, you can choose to use a contraceptive or family planning method that fits you. c. Consult a health care provider. Remember that each person has the right to free and informed consent regarding which family planning method to use. FURTHER READINGS FOR FACILITATORS  FACT SHEET on (Page 80-90) PREVENTING TEEN PREGNANCY 54  Sexually Healthy and Personally Empowered Adolescents PREVENTING SEXUALLY TRANSMITTED INFECTIONS (STIs) 56 SHAPE SESSION OBJECTIVES At the end of the session, participants are able to: 1. Explain STIs, including HIV, and how they are and they are not transmitted. 2. Discuss ways to prevent transmission of STIs and HIV. 3. Recognize sexual abstinence, correct and consistent use of condom as effective protection against STIs including HIV. 4. Discuss where and how to access local STI and HIV testing and treatment services. Time Allotment Materials Needed Methodology   90 minutes  Copy of fact sheets on STIs and HIV  Role playing and AIDS  Group discussion  For closing activity: Slips of paper (as many as the number of participants) Note: Write “+” on five slips of paper and “c” on another five slips of paper, fold all slips of paper, and place them in a box or envelope. OPENING ACTIVITY. Primetime (Role Playing) 1. Introduce the activity: a. People can experience both positive and negative consequences as a result of sexual intercourse or sex. It can result in pleasure, intimacy, and desired pregnancy. But sex can also lead to emotional and physical harm, unintended pregnancy, and STIs including HIV and AIDS. b. In this activity, we will discuss about STIs and HIV and AIDS. 2. Divide the participants into two groups. Assign each group a topic or allow them to choose between: STIs or HIV and AIDS. 57 PREVENTING SEXUALLY TRANSMITTED INFECTIONS (STIs)  Sexually Healthy and Personally Empowered Adolescents 3. Explain: a. In television, primetime refers to the time slot allocated to important programs or issues. Today’s primetime will focus on STIs among Filipino adolescents. b. In your group, create a five-minute talk show discussing the topic assigned to you or you have chosen. c. Be as thorough as possible. Include information about testing, treatment, and prevention. 4. Distribute the fact sheets. Give the groups five (5) minutes to prepare. 5. Ask each group to present its talk show and to take questions from the other group. 6. Make sure that important facts and prevention measures are covered in the discussion. 7. Process the activity by asking the questions: a. What did you feel when you were doing the activity? b. What lessons did you learn from the activity? KEY MESSAGES 1. Sexually transmitted infections (STIs) are infections spread through sexual activity. They are preventable. a. There are many kinds of sexually transmitted infections (STIs). Among the STIs that can have serious consequences are: HIV (the virus that causes AIDS), syphilis, gonorrhea, chlamydia, trichomonas, and herpes. b. In the early years of the HIV/AIDS epidemic (1984-1990), 62% (133 of 216 cases) of those diagnosed were female. From 1991 to present, males comprised 94% (52,539) of the 56,048 diagnosed cases in the Philippines. However, the number of diagnosed HIV infections among females has also been increasing in recent yearsiii. PREVENTING SEXUALLY TRANSMITTED INFECTIONS (STIs) 58 SHAPE  The number of females diagnosed from January to June 2018 (304) was almost three times the number of diagnosed cases compared to the same period of 2013 (110), five years prior. 93% (3,373) of all female cases were in the reproductive age group (15-49 years old) at the time of diagnosis.  The predominant age group among those diagnosed has shifted from 35-49 years old between 2001 to 2005, to 25-34 years ol